CO-13: Temporal evolution of cognitive changes in hypertension and potential effect modification by antihypertensive treatment status. VISAT cohort study

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• 作者：L. Rouch¹ ; P. Cestac¹ ; O. Hanon² ; C. Cool¹ ; C. Helmer³ ; B. Bouhanick¹ ; B. Chamontin¹ ; J. Dartigues³ ; B. Vellas¹ ; S. Andrieu¹
• 刊名：Annales de Cardiologie et d'Angeiologie
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：64
• 期：supp_S1
• 页码：S8
• 全文大小：71 K

文摘

Identifying modifiable risk factors for cognitive decline and dementia is crucial to effective preventive strategies. The aim of our study was to compare the cognitive trajectories of individuals with and without hypertension and to study potential effect modification by antihypertensive treatment status.

Methods

337 subjects from the VISAT study, a 10-year prospective multi-center cohort, were included. Data were collected at three cross-sectional time point in 1996, 2001 and 2006. Cognitive function, both memory and speed, was assessed. Hypertension was defined as either high blood pressure (greater or equal to 140/90) or current use of antihypertensive medication. Participants with hypertension were further divided into controlled hypertension, uncontrolled hypertension and untreated hypertension. Subjects with no medication use and normal blood pressure represented the control group. Linear mixed models for repeated data were used in our analyses.

Results

1105 participants (34%) were classified with baseline hypertension. They were on average older, more often men, had less education, a higher body mass index and more cardiovascular comorbidities. Hypertensive subjects had poorer cognitive performance at baseline, at 5 years of follow-up and finally at 10 years with more pronounced difference (–5.1, 95% CI [−6.37,−3.82], p < 0.001). All participants improved their performance in the first 5 years, probably due to an increased familiarization with the cognitive tests at follow-up, but hypertension was associated with a less pronounced improvement (chi2=21.22, p < 0.001). The pattern differed in the second time period. Hypertension was associated with a significant cognitive decline whereas subjects without hypertension slightly improved their cognitive performance (chi2=13.15, p < 0.001). Relative to those without hypertension, participants with uncontrolled and untreated hypertension (chi2=5.17, p = 0.02) showed evidence for cognitive decline as well as those with controlled hypertension. This group had more restricted decline although it was not fully protected. Comparing untreated and uncontrolled hypertension, untreated hypertension was associated with a faster cognitive decline. Finally, at 10 years of follow-up, subjects with untreated hypertension were those having the poorer cognitive function.

Conclusions

In our study, hypertension went with cognitive decline during follow-up, especially in the second time period which supports the idea of a slowly progressive effect of hypertension on brain functioning. For prevention, such a trajectory seems favorable, providing a window of opportunity for early treatment. Our results also suggest some benefit of antihypertensive treatment on brain health and stress the importance of tight and adequate blood pressure control.